Demodicosis Follow-up

  • Author: Manolette R Roque, MD, MBA; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jun 29, 2011
 

Further Outpatient Care

  • Eyelash scrubs twice daily with a 50-50 mixture of baby shampoo and water using a cotton swab or a rough washcloth provide symptomatic relief. The assumption that patients are knowledgeable about this procedure should not be made; demonstrating the eyelash scrub technique to the patient may be necessary.
  • The patient should be prescribed two 3.5-g tubes of a viscous ointment, preferably an antibiotic ointment, mercuric oxide ointment, or 10% tea tree oil ointment. The patient should be instructed to squeeze out 1 inch of ointment and apply liberally to each lid immediately before bedtime. This is believed to inhibit the reproductive attempts of the adult Demodex. The patient is also instructed to wash out the ointment every morning with the eyelash scrubs.
  • Preventive facial hygiene with daily soap and water washes is encouraged. Long-term compliance may be a problem in patients with dry skin.
  • Dermatologic consultation may be helpful in a patient with recurrent episodes or in those with accompanying dermatologic involvement.
  • Typically, 3-4 weeks of treatment is necessary. In patients who respond to the above outlined treatment, the eyelid scrubs may be reduced to once a day and an ointment at bedtime.
  • Consequently, the treatment is reduced until the condition resolves or recurs. If recurrence of symptoms occurs during the tapering period, the patient is advised to go back to the previous treatment level and to continue at that level.
  • If the patient is unresponsive to treatment, consider noncompliance or other underlying etiologies.
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Inpatient & Outpatient Medications

  • 50-50 mixture of baby shampoo and water
  • Erythromycin ointment
  • Mercury oxide 1% ointment
  • Pilocarpine 4% gel
  • 10% tea tree oil ointment
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Prognosis

  • The prognosis of symptomatic relief from D folliculorum is very good.
  • Previous clinical experience shows that total eradication is unlikely, but the mite population can be brought down to an acceptable level with little effort and easily maintained with proper hygiene.
  • There are promising reports of total eradication with the use of tea tree oil.
  • Recurrence of the symptoms is possible if proper hygienic measures are not used.
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Patient Education

  • The suggested home treatment, including the eyelash scrub technique, should be demonstrated to the patient.
    • Soak the washcloth in warm water, and wring it.
    • Apply enough baby shampoo to form lather on the washcloth.
    • With the eye closed, massage the lashes on the lid margin, moving from left to right, 15 times. (Do not touch the eye itself.) Repeat on the other eye.
    • Rewet the cloth, and rinse off the shampoo.
    • Squeeze 1 inch of the ointment onto the index finger and gently rub into the lashes with the eye closed. Repeat on the other eye.
  • To the eye care professional, the presence of Demodex species together with signs or symptoms of lid inflammation is of greater concern than the prevalence of Demodex species in a general population.
  • Tea tree oil and tea tree oil shampoo may be purchased from specialty shops locally and online.
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Contributor Information and Disclosures
Author

Manolette R Roque, MD, MBA  General Manager, Full Partner, Ophthalmic Consultants Philippines Co.; President and CEO, Chief Refractive Surgeon, EYE REPUBLIC Ophthalmology Clinic; Section Chief, Ocular Immunology and Uveitis, Department of Ophthalmology, Asian Hospital and Medical Center; Section Chief, Ocular Immunology and Uveitis, International Eye Institute, St Luke's Medical Center Global City; Senior Eye Surgeon, The LASIK Surgery Clinic; Director, AMC Eye Center, Alabang Medical Center; President, Philippine Ocular Inflammation Society

Manolette R Roque, MD, MBA is a member of the following medical societies: American Academy of Ophthalmic Executives, American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, American Society of Ophthalmic Administrators, American Uveitis Society, International Ocular Inflammation Society, Philippine Medical Association, Philippine Ocular Inflammation Society, and Philippine Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Barbara L Roque, MD  Full Partner, Ophthalmic Consultants Philippines Co; Service Chief, Pediatric Ophthalmology and Strabismus, Department of Ophthalmology, Asian Hospital and Medical Center; Active Staff, International Eye Institute, St Luke's Medical Center Global City; Visiting Ophthalmologist, AMC Eye Center, Alabang Medical Center

Barbara L Roque, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Cataract and Refractive Surgery, Philippine Academy of Ophthalmology, Philippine Society of Cataract and Refractive Surgery, and Philippine Society of Pediatric Ophthalmolo

Disclosure: Nothing to disclose.

C Stephen Foster, MD, FACS, FACR, FAAO  Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institution

C Stephen Foster, MD, FACS, FACR, FAAO is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Association of Immunologists, American College of Rheumatology, American College of Surgeons, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, American Uveitis Society, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, Royal Society of Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Fernando H Murillo-Lopez, MD  Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgments

The author was a fellow and affiliated with the Ocular Immunology and Uveitis Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, while performing this work.

References

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Illustration of Demodex folliculorum. Reprinted from BIODIDAC, Arthropoda Chelicerata Demodex, submitted by Livingstone, with permission from Antoine Morin, Biodidac, University of Ottawa.
Eyelid section shows Demodex folliculorum (M) in the hair follicle. Note mite mouthparts (arrow) embedded in epithelium and straplike layers of keratin (hematoxylin and eosin, X400). Reprinted from Am J Ophthal Vol. 91, English FP, Nutting WB, Demodicosis of Ophthalmic Concern, 362-372, 1981, with permission from Elsevier Science.
Section of sebaceous gland of an eyelash shows Demodex brevis (M). Note gland cell (C) destruction (McManus, X375). Reprinted from Am J Ophthal Vol. 91, English FP, Nutting WB, Demodicosis of Ophthalmic Concern, 362-372, 1981, with permission from Elsevier Science.
Cross-section through small hair follicle of the eyelid. Note distension, hyperplasia, and moderate epithelial keratinization caused by the activities of Demodex folliculorum (arrow) (hematoxylin and eosin, X375). Reprinted from Am J Ophthal Vol. 91, English FP, Nutting WB, Demodicosis of Ophthalmic Concern, 362-372, 1981, with permission from Elsevier Science.
Section of eyelid shows eyelash (L), cuffing (C), and small segment of Demodex folliculorum (M). Note layering of cuff (Masson, X275). Reprinted from Am J Ophthal Vol. 91, English FP, Nutting WB, Demodicosis of Ophthalmic Concern, 362-372, 1981, with permission from Elsevier Science.
Demodex folliculorum.
Demodex along the shaft of the cilia.
Demodex along the shaft of the cilia (higher magnification).
Backsides of numerous pubic crabs with infestation of the lashes and secondary blepharitis. Reprinted with permission from H.D. Riley, OD, Indiana University School of Optometry.
Phthiriasis (Phthirus pubis) pubic crab lash infestation and secondary blepharitis. Reprinted with permission from H.D. Riley, OD, Indiana University School of Optometry.
Phthiriasis (pubic lice). Reprinted with permission from H.D. Riley, OD, Indiana University School of Optometry.
 
 
 
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